Work tests to evaluate cardiorespiratory fitness

Dr. Imran Rafiq

Objectives
1.Identify the sequence of steps in the procedures

for evaluating cardio respiratory fitness (CRF). 2.Describe one maximal and one submaximal field test used to evaluate CRF. 3.Explain the rationale underlying the use of distance runs as estimates of CRF. 4.Identify the common measures taken during a graded exercise test (GXT). 5.Describe changes in the ECG that may take place during a GXT in subjects with ischemic heart disease.

Outline
Testing Procedures Screening Resting and Exercise Measures Field Tests for Measuring CRF Maximal Run Tests Walk Tests Canadian Home Fitness Test Graded Exercise Tests:Measurements Heart Rate Blood Pressure ECG Rating of Perceived Exertion Termination Criteria VO2max Estimation of VO2 max from Last Work Rate Estimation of VO2 max from Submaximal Heart Rate Response Graded Exercise Test:Protocols Treadmill Cycle Ergometer Step Test

Screening
Signing consent form Physical Activity Readiness Questionnaire (PAR-Q)

PAR med X Highlights absolute and relative contraindications for exercise

ACSM Risk Stratification

Low risk Men <45 yr, women <55 yr, asymptomatic, 1 risk factor
Moderate risk Men 45, women 55, or 2 risk factors High risk 1 sign or symptom or known disease

of Cardio respiratory Fitness

Resting and Exercise Measures

Resting

measures Heart rate and blood pressure Cholesterol ECG

Exercise measures (GXT or field test) Heart rate Blood pressure ECG Symptoms Angina pectoris Dyspnea

In Summary
The steps to follow before conducting an exercise test

to evaluate CRF include: a. signing of a consent form b. screening c. obtaining resting HR and BP as well as cholesterol and ECG measures.

Field Tests for Estimating Cardiorespiratory Fitness

Maximal Run Tests

Measure how far a person can run in a set time or how fast they can run a set distance Coopers 12-minute run and 1.5-mile run For adults AAPHERDs 1-mile run/walk and PACER test For children DISADVANTAGES Physiological responses may be difficult to measure

Involve maximal effort not gradedThese field tests should be used only after a person has progressed through a program of exercise at lower intensities.

ADVANTAGES Natural activity- Walking, running, or stepping Can test large numbers of people at low cost VO2 max estimates based on the linear relationship between running speed and oxygen cost of running Duration of 1020 minutes Running at speed demanding 9095% VO2max Minimize contribution of anaerobic energy sources

 Calculating VO2 from running speed

VO2 = 0.2 mlkg1min1per m. min1 + 3.5 mlkg

1min1
Calculating VO2 from walking speed VO2 = 0.1 mlkg1min1 .per m. min1 + 3.5 mlkg

1min1

Walk Tests
One-mile walk test requires simple measurements VO2max is based on: Age (years), weight (pounds), sex (0 for female, 1for male), time (min), and HR (beats/min) VO2(mlkg1min 1) = 132.853 0.0769 (wt) 0.3877(age) + 6.315 (sex) 3.2649 (time) 0.1565 (HR) As fitness improves, HR and/or time will be lower Results in higher estimated VO2max

Canadian Home Fitness Test

Uses 8-inch steps to evaluate cardiorespiratory fitness Measure HR after 3 minutes of stepping Stop if it exceeds maximum allowable HR based on age Continue for another 3 minutes if it is below maximum allowable HR Fitness level is based on post-exercise HR

In Summary
Field tests for CRF use natural activities such as walking, running, and stepping in which large numbers of people can be tested at low cost. However, for some, physiological responses are difficult to measure, and motivation plays an important role in the outcome. VO2max estimates from all-out run tests are based on the linear relationship between running speed and the oxygen cost of running. The Canadian Home Fitness Test is a step test that uses conventional 8-inch steps to evaluate cardiorespiratory fitness.

Graded Exercise Tests

Cardio respiratory fitness measured using: Treadmill Cycle ergometer Stepping bench Incremental tests Work rate increases every 23 minutes until predetermined endpoint is reached Tests can be maximal or submaximal

Heart Rate
Measured by Palpation Carotid or radial artery Stethoscope On chest wall ECG Heart rate displayed on monitor Measured during exercise or in recovery Recovery HR should be measured within first 15seconds

Blood Pressure
By auscultation During walking or cycling exercise Subject should not be holding handlebar Systolic BP First Korotkoff sound Diastolic BP Fourth Korotkoff sound

Three types of St segment depression

ECG

Rating of Perceived Exertion (RPE)

Original 620 scale and revised scale (010) Indicator of subjective effort Way to track progress through a GXT Can be used to prescribe exercise
Instructions During the exercise test we want you to pay close attention to how hard you feel the exercise work rate is. This feeling should reflect your total amount of exertion and fatigue, combining all sensations and feelings of physical stress, effort, and fatigue. Dont concern yourself with any one factor such as leg pain, shortness of breath, or exercise intensity, but try to concentrate on your total, inner feeling of exertion. Try not to underestimate or overestimate your feeling of exertion; be as accurate as you can.

Termination Criteria
Include signs and symptoms Depend on: Population being tested Purpose of the test ACSMs Guidelines for Exercise Testing and Prescription Appropriate for non diagnostic GXTs

In Summary
Typical measurements obtained during a graded exercise test include heart rate, blood pressure, ECG, and rating of perceived exertion. Specific signs (e.g., fall in systolic pressure with an increase in work rate) and symptoms (e.g., dizziness)are used to stop GXT.

VO2Max
The gold standard measure of cardio respiratoryfitness Very reproducible on same work instrument Depends on work instrument Highest on treadmill Walking ~6% lower than running Lower (~511%) on cycle ergometer Arm ergometer values 70% of leg ergometer

Estimation of VO2Max From Last Work Rate

Direct measurement of VO2 max is often not practical Complex and costly procedures Can use equations to calculate estimated VO2max from last stage of GXT Must allow time for subject to reach steady state in each stage

Estimation of VO2 Max From Sub maximal Heart Rate Response

Measure HR at several sub maximal work rates Up to 7085% predicted maximal HR Extrapolate sub maximal HR to estimate VO2 max A line is drawn through the HR points measured during the test and extrapolated to the age-adjusted estimate of maximal HR Another line is dropped down from that point to the x-axis, and the VO2 max is identified Problems SD of Age-predicted maximal HR is 11 beatsmin1
Can result in over- or underestimation of VO2max Other factors affect sub maximal HR response e.g., dehydration, temperature, medications

Estimation of VO2 max From Submaximal Cycle Ergometer Test

In summary
The measurement of VO2 max is the gold standard measure of cardiorespiratory fitness.
VO2 max can be estimated based on the final work rate achieved in a graded exercise test. VO2 max can be estimated from heart rate responses to submaximal exercise by extrapolating the relationship tothe subjects age-adjusted estimate of maximal heart rate. Careful attention to environmental factors that can affect the heart rate response to submaximal exercise isan important aspect of the procedures for these tests.

Graded Exercise Test: Protocols

Consideration of the population tested Submaximal vs. maximal test Starting work rate Rate of change of work rate Mode of exercise Treadmill Cycle ergometer Step test Subjects must follow instructions carefully Environmental conditions must be controlled Temperature and humidity

Treadmill
Use natural activities Walking and running Can accommodate a wide range of subjects Least fit to most fit Involve increasing speed and/or grade Estimating VO2max Usually based on extrapolating submaximal HR Test terminated at 85% age-predicted maximal HR Could also be a single-stage test

Estimation of VO2 Max from Submaximal Treadmill Test

A single-stage submaximal treadmill test has been validated for use with low-risk subjects who are likely to have average values for V02 max . In this test the treadmill is set at 0% grade, and a walking speed is set between 2 and 4.5 mph to elicit a heart rate between 50% and 70% of age-adjusted maximal HR. Following this four-minute warmup, the grade is elevated to 5% for four minutes. HR is measured in the last minute and used with speed (S in mph), age (A in years), and gender (G, with female = 0 and male = I) in the following regression equation to predict V02 max V02 max = 1 5.1 + 21 .8 (S) - 0.327 (HR) - 0.263 (S X A) + 0.00504 (HR X A) + 5.98 (G)

Cycle Ergometer
Body weight is supported Can accommodate subjects with orthopedic limitations Work rate depends on resistance and pedal rate Generally, pedal rate is maintained and resistance is increased Estimating VO2max Based on extrapolating submaximal HR during incremental test

Step Test Simple, inexpensive equipment Protocols differ in: Step height Step rate Estimating VO2max Based on extrapolating submaximal HR

Predicting VO2 Max from Submaximal Step Test

In Summary
VO2 max can be estimated with the extrapolation procedure using the treadmill, cycle ergometer, or step. The subject must follow directions carefully and environmental conditions must be controlled if the estimate of VO2 max is to be reasonable and reproducible